S197 S290
Setting:
Outpatient lymphedema-rehabilitation clinic.
Results:
Patient underwent a thorough evaluation where no clear
cause of left upper extremity lymphedema was found. Based on
diagnosis of exclusion, the patient was diagnosed with SLE-induced
lymphedema and was referred to the rehabilitation clinic for further
treatment. The patient was managed with conservative treatment
including physical therapy for manual lymphatic drainage, compres-
sion and wrapping.
Discussion:
Damage of the lymphatic drain system resulting in lym-
phedema is often seen as a consequence of cancer treatment.
Resection of axillary lymph nodes as part of the treatment of breast
cancer is the most common cause of upper extremity lymphedema.
Other causes include infection and trauma of the lymphatic system.
Even though pitting edema is often associated to SLE vasculitis and
medication side effects, lymphedema is rarely observed. The patho-
physiology is not clear, however antibody-related injury is suspected.
Conclusions:
Lymphedema is a rare complication of SLE and other
causes should be ruled out, including malignancy. Once diagnosis is
confirmed, a comprehensive functional evaluation should be per-
formed and conservative lymphedema treatment should be in place to
avoid further complications.
Level of Evidence:
Level V
Poster 203:
Inpatient Rehabilitation for Thoracic Myelopathy
Caused By X-Linked Hypophosphatemia, a Form of
Congenital Rickets, After Surgical Decompression and
Fusion: A Case Report
Jennifer Do, DO (University of Arkansas for Med Sciences),
Thomas S. Kiser, MD MPH
Disclosures:
Jennifer Do: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 56-year-old woman with X-linked
hypophosphatemia (XLH) underwent more than 30 orthopedic sur-
geries during her life to address progressive bone deformities and
spinal stenosis. In more recent years, she has been managed for
chronic back and leg pain from thoracic and lumbar stenosis, sensory
changes of the lower extremities, knee pain status post bilateral total
knee arthroplasties, and degenerative hip arthritis. She has been fairly
independent for most of her life, using a power wheelchair for mobility
for the last 12 years and ultilizing hand controls and a van lift to drive.
In the past year, however, her functionality greatly declined. Intrac-
table back pain caused her to forgo driving and her ability to transfer
was impaired to the point that her husband had to carry her for
transfers. She discontinued her favorite pastime, swimming, and lost
120 lbs using a starvation diet to lose weight in an attempt to alleviate
the pain that immobilized her. Her orthopedic surgeons ordered
thoracic and lumbar CT myelograms to investigate beyond the unim-
pressive MRI findings. They discovered severe multilevel foraminal
stenosis with hardware loosening at T4 and severe bilateral facet
arthropathy causing posterior deviation of the spinal cord. They per-
formed posterior decompression of T6-7 and reinstrumentation and
fusion of T2-T8.
Setting:
Acute care hospital, Acute inpatient rehabilitation hospital.
Results:
The first morning of her admission to acute inpatient
rehabilitation, she actually stood to transfer. She ambulated
for the first time in 12 years, able to walk 8 feet upon discharge
from inpatient rehabilitation and 75 feet by her first orthopedic
follow up.
Discussion:
This is a case of a remarkable functional outcome after
surgery and inpatient rehabilitation in a patient with chronic, pro-
gressive orthopedic debility.
Conclusions:
Close multidisciplinary and continuous rehabilitation
management in a patient with XLH is imperative for positive patient
outcomes.
Level of Evidence:
Level V
Poster 204:
Creation of Bilateral Above Elbow Functional
Prostheses for a Toddler Using Three-Dimensional
(3D) Printing Technology: A Case Report
Cesar Colasante, MD (State University of New York), (SUNY) Upst,
Bronx, NY, United States), Andrew L. Peredo, MD, Yuxi Chen, MD,
FAAPMR, Matthew N. Bartels, MD, MPH, FAAPMR
Disclosures:
Cesar Colasante: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
3D models of the arms of a 3-year-old
boy with congenital bilateral standard length above elbow amputa-
tion were generated using structured light scanning. These models
were used to create bilateral upper arm sockets with friction elbow
joints that articulate with a forearm. The forearm was designed with
a wrist friction joint articulating with a voluntary-close (VC) pre-
hensile hand as terminal device (TD). The entirety of the device is
suspended by an adjusting 8-point harness. The hand is driven by
scapular protraction as well as shoulder abduction/adduction
depending on the harness adaptation used. Training in the use of the
devices was performed by occupational therapist in scheduled bi-
weekly sessions.
Setting:
Academic Medical Center.
Results:
Functional 3D printed above elbowprostheseswere created and
placed on a 3-year-old patient. The patient was able to grasp objects.
Discussion:
3D printing can be used to generate custom functional
above elbow prosthesis. This method permits scaling and reprinting as
needed to compensate for the patient’s growth preventing extended
periods of time without the use of the prostheses. Missing milestones
in function and control of upper-limb prosthetics during early life is a
predictor of non-adherence to prosthetic use as a teenager or adult.
Although not insignificant, the cost is significantly lower compared to
traditional prosthesis.
Conclusions:
3D printing can be used to create above elbow prosthesis in
the pediatric population as a bridge to a definitive prosthesis while avoiding
extended periods of time without prostheses and missing important mile-
stones in learning the control of the device. The aforementioned could
improve patient’s adherence to the use of devices later in life.
Level of Evidence:
Level V
Poster 205:
Myositis Ossificans Causing Compression Neuropathy
of the Ulnar Nerve: A Case Report
Morgan L. Pyne (University of South Florida)
Disclosures:
Morgan Pyne: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
The patient suffered severe trauma from a
car vs. motorcycle collision, resulting in an inferior left iliac bone
fracture, left patella fracture, scapular body fracture, multiple dis-
placed rib fractures, T8-T11 transverse process fracture, left brachial
plexus injury, along with multiple other injuries. The patient presented
to the rehab floor 6 days after the accident with two palpable hema-
tomas, one over the right brachialis and the other over the left quad-
riceps muscle. A month later, the patient started to develop pain with a
decrease in range of motion in his left hip. X-rays revealed extensive
heterotopic ossification encapsulating the joint. Around this same time
the patient started to develop a right ulnar neuropathy, resulting in
“clawing” of his right hand. Electrodiagnostic testing revealed ulnar
neuropathy at or above the elbow. X-rays suggested and MRI confirmed
myositis ossificans compressing the right ulnar nerve.
Setting:
Inpatient Rehabilitation Unit.
Results:
Three months after the initial injury, the Orthopedic Sur-
gery team was asked to evaluate the patient for possible removal of
the myositis ossificans. Although typically surgery is withheld for 12
to 18 months after heterotopic ossificans or myositis ossificans is
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Abstracts / PM R 9 (2017) S131-S290